Chest
Original ResearchChest InfectionsReversed Halo Sign in Invasive Fungal Infections: Criteria for Differentiation From Organizing Pneumonia
Section snippets
Materials and Methods
All participating institutions provided institutional review board approval for this study (MD Anderson Cancer Center Protocol ID No. PA12-0047, Universidade Federal do Rio de Janeiro-Comitê de Ética e Pesquisa–Protocolo No. 089/10; the other institutions waived the institutional review board), and the requirement for informed patient consent was waived. We retrospectively reviewed the CT scans and medical records of 15 patients with IFI (invasive pulmonary aspergillosis or zygomycosis) and 25
Results
A single lesion with the RHS was observed in 13 of 25 patients with OP (52%). More than one lesion with the RHS was noted in the remaining 12 patients (48%). Associated parenchymal abnormalities were detected in 12 patients (48%), characterized as consolidations, ground-glass opacities, and linear opacities. No patient presented with lymph node enlargement or pleural effusion. No RHS lesion in the OP group exhibited reticulation of its inner component. The average maximal thickness of the
Discussion
We found that the presence of a pleural effusion associated with the RHS and the morphologic characteristics of the RHS can help differentiate patients with IFI from those with OP. An effusion was present in 73% of patients with IFI and in no patient with OP. In patients with IFI, central reticulations of the RHS were common (93%), and the outer consolidation rim was thick (average, 2 cm); in contrast, no RHS central reticulation was observed in patients with OP, and the outer consolidation rim
Acknowledgments
Author contributions: Dr Marchiori was the principal investigator and is the guarantor of the entire manuscript.
Dr Marchiori: contributed to the coordination and design of the study, data interpretation, and revision of the manuscript.
Dr Marom: contributed to the high-resolution CT scan evaluation, literature review, and revision of the manuscript.
Dr Zanetti: contributed to the data interpretation, literature review, and revision of the manuscript.
Dr Hochhegger: contributed to the collection of
References (19)
- et al.
Pulmonary histoplasmosis presenting with the reversed halo sign on high-resolution CT scan
Chest
(2011) - et al.
Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis
Chest
(2011) - et al.
Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT
Eur J Radiol
(2011) - et al.
The reversed halo sign. Another CT finding useful for distinguish invasive pulmonary aspergillosis and pulmonary lymphoma
Eur J Radiol
(2011) - et al.
Reversed halo sign: high-resolution CT findings in 79 patients
Chest
(2012) - et al.
Fleischner Society: glossary of terms for thoracic imaging
Radiology
(2008) - et al.
Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications
AJR Am J Roentgenol
(2003) - et al.
The reversed halo sign on high-resolution CT in infectious and noninfectious pulmonary diseases
AJR Am J Roentgenol
(2011) - et al.
Reversed halo sign in invasive pulmonary fungal infections
Clin Infect Dis
(2008)
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2020, ChestCitation Excerpt :Often associated with air bronchograms, peribronchovascular nodules may coalesce and form consolidation in contiguity with the bronchi and pulmonary arteries, resulting in the loss of the normal interfaces with these structures. The range of pathology in this group includes cryptogenic organizing pneumonia, various infections, especially those related to underlying immunocompromise, lymphoproliferative diseases, and sarcoidosis (Fig 20).21,22 This list would also include other causes of noninfectious granulomatous disease such as granulomatosis with polyangiitis and, in the appropriate clinical setting, Kaposi’s sarcoma.
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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